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Clinician collected for NAAT/culture/microscopy Urethral swabs for microscopy should be collected when the patient has not urinated for at least 1 hour and only if the patient has frank urethral discharge. Squeeze the urethra to express the discharge and collect on urethral swab. It is not necessary to insert the swab into the urethra.

Rectal swabs should be collected by inserting a sterile swab 2-4cms into the anal canal and moving the swab gently side to side for 10-20 seconds.

Pharyngeal swabs should be collected from the tonsils and oropharynx.

High vaginal swab of vaginal discharge smeared onto a glass slide, air dried and sent for microscopy. Swab inserted into transport medium for culture.

Non-steroidal anti-inflammatory drugs (such as ibuprofen or naproxen ), and aspirin may decrease redness and pain. [47] [48] Local anesthetics such as benzocaine , however, are contraindicated. [49] Schwellnus et al. states that topical steroids (such as hydrocortisone cream ) do not help with sunburns, [48] although the American Academy of Dermatology says they can be used on especially sore areas. [49] While lidocaine cream is often used as a sunburn treatment, there is little evidence for the effectiveness of such use. [50]

Principal Treatment Options Situation Recommended Alternative Initial episode Valaciclovir 500mg PO, BD for 5 - 10 days Aciclovir 400mg PO, TDS for 5 - 10 days Recurrence: Episodic therapy Valaciclovir 500mg PO, BD for 3 days Famciclovir 1g PO, BD for 1 day Recurrence: Suppressive therapy Valaciclovir 500mg PO, daily for 6 months Famciclovir 250mg PO, BD for 6 months Treatment advice

  • Treatment should not be delayed for those presenting with severe episodes, particularly initial episodes.
  • Initial episodes may require a longer duration of treatment.
  • Limited evidence comparing other antiviral agents (aciclovir and famciclovir) with valaciclovir indicates that they are therapeutically equivalent. The ability for the patient to adhere to the recommended dosing frequency should be considered when selecting the appropriate treatment.
  • Choice of suppressive therapy, episodic therapy or no therapy depends on clinical features including frequency and severity of recurrences.
  • Review need for suppressive therapy six monthly as recurrences usually become less frequent and severe with time.
  • Those with very frequent recurrences or immunosuppression may require higher doses.
  • Ongoing symptoms, despite antiviral treatment, should prompt consideration of other causes of genital symptoms.
Other immediate management
  • Written information and support (.  Genital Herpes – The Facts )
  • Simple analgesia and antipyretics
  • Saline bathing
  • Topical lignocaine reduces pain from erosions
  • Urinating in a bath or shower relieves superficial dysuria
  • Neuropathic bladder requires catheterisation until resolution
  • Encourage condom use with ongoing partners
  • Herpes is not a notifiable condition.

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